The objective of this study is to describe the knowledge of HIV/Aids and risky behavior of male sex workers (MSWs) in Larkana city, Pakistan. This is an exploratory research based on primary data. The data have been sampled through snow ball sampling method.Numerous sexual partners, un protected anal intercourse and sexual relations with drug addicts (Intra Venus drug users) put MSWs on increasing risk of sexually transmitted diseases (STDs) and HIV/Aids infection. Results show that 86% MSWs had sexual relations with drug users and 54% had unprotected sex in last month. Only 46% respondents aware regarding HIV/Aids and 35% know the center where they can get clinical HIV test and 0% respondents have undergone any medical/HIV test.

Introduction:Commercial sex work is a basic feature of homosexual men in his sexual life. Since 1947, Pakistan has been trying to stable its foreign exchange. Due to political destabilization, country’s economic growth was badly suffered. People involve in low cost sex likewise male with male etc due to economic instability. Pakistan is an Islamic state according to constitution, where law or culture, custom can integrate religion in all codes and values. Sex without marriage, including homosexual relations are still taboos in Pakistan (Shafique, 2006)1. Under the umbrella of Islam any kind of sexual relation excluding marital relations are haram (Strictly forbidden). Therefore most people believe that HIV/Aids through illicit sexual relations are not problem of Muslim world (Osteria, 1991)2. While scenario is different on ground level. In Pakistan ratio of HIV/Aids infected men is seven time higher than women (Rajab et al. 2008)3. Olaleye (2003)4 describes that, Acquired Immune Deficiency Syndrome (AIDS) is a viral infection caused by Human Immunodeficiency Virus (HIV). This virus usually found in body fluid (blood, semen, vaginal fluid and breast milk) of infected person. This virus can be transferred from infected person to healthy person through unprotected sexual intercourse and sharing of un sterilized medical instruments or infected shaving kits. Near the railway station of Larkana, in the middle of city, various hotels, motels and tea stalls are available for passengers as well as local community. Here people can hire one small bed room and bath room on cheap price. These type of hotels call “MusafirKhana” (Altaf, 2012)5. These hotels are popular for male sex workers (Male Prostitutes). MSWs hire a number of rooms in these hotels and clients visit them all the day for anal or oral sex. These male prostitutes are high vulnerable group to HIV. These MSWs exchange sex for money and some time they involve in un safe sex on demand of client. Most of the clients are gay or bisexual male and some of them have female sex partners (Mores et al. 1991)6. Male prostitutes charge Pak. Rs: 150 – 250 per one sexual interval according to satisfaction of client (Avais, 2014). While un skilled worker earn hardly Pk. Rs: 250 – 350 after all day (minimum 08 hours) work. Logon (2013)7 identified that market features of male sex workers are unrevealed. Usually people assume that male prostitution is a moral issue and it is associated with deviation of gander (Scott et al., 2005)8. Male sex workers have very little existence in sex industry. As compare to female sex workers, MSWs work independently. A lot of quantitative work available on female sex workers (Lillard, 1998)9. Very limited work on male sex worker is available in developing countries (Shah, 2013)10 especially in Pakistan due to high moral and religious restrictions. In 2012, 27.7% out of 100 HIV reported cases belonged to Larkana and in first seven month of 2013, 45.1% out of 100 HIV positive patients belonged to 15 – 25 years age group & 39.7% reported cases belonged to Larkana (Memon, 2014)11 and It is estimated that there are 1,698 male & hijra sex workers available for paid sex in Larkana. Halkities et al. (2004) argued that male sex workers have higher risk of sexually transmitted diseases (STD), including HIV.

Literature Review: There is not been much research literature availableon the perception, attitude and awareness of MSWs regarding HIV/Aids. It is noted that education may change the attitudes and can increase level of realistic knowledge in sexual practice (Grunseit, 1998)12. Khan (2009)13 argued that data on structural or social drivers of HIV/Aids risk among MSWs in Pakistan is scare. Caceres, (2006)14 noted that 5% to 10% HIV/Aids infections in world are transmitted through unprotected sex between male and male. Unprotected anal intercourse is main route of HIV/Aids transmission in MSWs (Herbert et al., 2005)15. Johnson et al. (2008)16 argued that behavioral interventions can reduce unprotected sex among MSWs.

Locale: Larkana city is situated on right bank river Indus. According to population welfare department in 2010 the total population of district is around 1.4 million while population of Larkana city is 539,075 (Memon et al. 2014)17.

Objectives: The main objective of the study is to find out awareness regarding HIV/Aids in MSWs and sexual behavior of MSWs.

Research Methodology: This is an exploratory research based on primary data. The data has been sampled through snow ball sampling method.37 male prostitutes were selected from Larkana city.In depth interviews were conducted. Clients of all the respondents are male. The male prostitutes those serve for female are not included in this research.

Analyses of Data: The result indicates that 46% male sex workers (MSWs) know regarding HIV/Aids and majority of the respondents 54% don’t know regarding HIV/Aids. Unawareness is itself very dangerous for MSWs. Due to unawareness MSWs involve in unprotected sex and they are more prone to be infected by HIV. Moreover long involvement in sexual activities and involvement in sex during teen age can become causes of HIV/Aids infection in MSWs. 57% MSWs live alone and they are easily available for sexual satisfaction in day or night. 24% MSWs lives with their friends. These friends may be their permanent customers or group of other MSWs. Only 19% MSWs live with

their families. 78% respondents had not condom at the time of interview and 54% respondents had unsafe sexual relation with in last month. While 46% respondents had not unsafe sex with in last month and 22% respondents had condom at the time of interview. Multiple partners increase risk of HIV/Aids in homosexual population. It is noted that MSWs are involved in spreading of HIV Infection (Halkitis et al., 2004)18. Respondents believe that HIV/Aids spread through, un safe sex with male 56%, through dentist 57%, through re used syringes 65%, un safe sex with female 81%, through tattoos on body 24% and staying filthy 51%. 86% respondents have had sexual intercourse with drug addicts in last month. 65% respondents don’t know regarding where about of government/ medical health center there they can go for treatment in case of STD or HIV screening. 100% respondents never gone through HIV screening test. 78% respondents self-medicate in case of illness while 22% visit the doctor either qualified or quake.

Conclusion:The study was conducted under many limitations. The data was collected from small sample and cannot be generalized to whole Larkana city. The interview were conducted through snowball sampling technique. The MSWs those serve to women are not part of this study. It must be noted that prostitution itself is strictly banned in Islam. Therefore data is self-reported by MSWs on very sensitive topic and not easy to verify. The data indicates that a high active community of MSWs & clients of MSWs are present in study area. MSWs have little knowledge regarding HIV/Aids. Multiple sexual partners put the MSWs at high risk of STDs and HIV/Aids infection. Condom use is low and they are habitual to self-medicate. Therefore these MSWs may cause of spread of infections due to travel to other parts of Sindh as well as Pakistan. Government as well as NGOs are running many HIV awareness programmes in Sindh but the ground situation is very different.

Suggestions: Health care services must be developed on ground level and they must be advertised. These facilities must be available near to the sites where sex workers and clients meet. Increasing knowledge of HIV/Aids may impose positive effect and build safe & HIV/Aids free environment in community.

C Cáceres, K Konda, M Pecheny. (2006). A Chatterjee and R Lyerla. Estimating the number of men who have sex with men in low and middle income countries. Sexually Transmitted Infections; 82(suppl_3):3-9